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My health center, Alvernon Family Medicine, in the heart of Midtown Tucson is surrounded by vibrant communities from around the world. Our physicians, nurse practitioners, residents, nurses and staff pride ourselves as the medical home for a diverse patient population, with as many as a quarter of our patient visits made by individuals and families who came to this country as refugees from war-torn regions of Africa, the Middle East, and South Asia. While we struggle with visits prolonged by translator phones and managing the health needs in resource-challenged communities, we know we provide great care to many who refer more from their community to us day after day.

As I listen to the vitriol from the highest levels of our government — painting refugees as dangerous and taking advantage of us — my patients I’ve cared for over the last two years prove the opposite. They’ve reminded me of how lucky I am to be an American, our role in ensuring human rights for families that have fled their homes for a second chance at life, and how they keep America great.

In the fall of 2004, my last year of medical school, I spent nearly 3 months in South Asia.

India, the country where my parents were born and raised and where nearly all my relatives still live, had historically been a regular destination for me. The fall of 2004 was an opportunity to visit my grandparents, uncles and aunts, and cousins, experience Diwali and a host of other festivals in India for the first time, explore the city of Mumbai independently, and travel through historic cities of Sri Lanka and Tamil Nadu state in Southern India.

Demon King Raven Effigy during Navratri

Roaming the Streets of Surat

New Years Pooja to Books

Ganesh Festival, Mumbai

The technical reason I was in India, however, was to complete two month-long elective rotations as part of my medical education. I spent a month in Surat (Gujarat State’s second city, a few hours north of Mumbai) at a private pediatrics hospital seeing burgeoning services for the rising middle class, with some additional time at an aunt’s homeopathic clinic. I also spent a month at KEM Hospital in Mumbai, a government hospital for Mumbai’s indigent population.

The cold, the snow, the congestion / traffic / population density, the violence, the cost-of-living, the corruption and psuedo-democracy. Whatever the albatross, most people in Chicago at some point in the course of the year (for some, on a daily basis!), threaten to finally get out of dodge.

In fact, in a recent Gallup 50-state survey, residents in Illinois were more likely to say that they would like to relocate than those of any other state! Half of Illinoisans want to leave! And nearly 20% say that they are likely to move.

Now granted, inertia is a VERY strong force, and a fifth of Illinois residents are not going to leave the state. So most of our friends are surprised that the Grivois-Shah family has beaten inertia and are making the leap across the country to the deserts of Tucson, Arizona.

But regardless of how much I’ve decried living in Chicago, I will miss the city that I called home for the first three and a half decades of my life: born and raised in the western suburbs, college, medical school, and residency all in the heart of the city. I’ve never called another place home.

While I’m looking forward to the warmth, pace, and lower-cost living of Tucson, there are a number of things that make leaving Chicago tough. Below is a short list of 5 things I’ll definitely miss about Chicago.

It’s the marquis turf battle that’s sexy and exciting for journalists, politicians, and healthcare groups. State-by-state changes have been giving nurse practitioners (NPs) more and more (sometimes less) ability to practice more medicine with less supervision.

In many states and federally, expansion of NP scope of practice has, by the viewpoint of many physicians and physician groups, become the Pandora’s Box that will reshape primary care for the worse, challenge the future of the profession of primary care physicians, increase healthcare costs, and cause great harm to patients and communities. Full legal independent scope to practice medicine is the line in the sand that most states yet have not crossed, requiring NPs to have a “collaborative agreement” with a physician who “supervises” their care of patients.

I’m jealous of all the people still riding their bikes to work. My cold-weather clothes that got me to work on bike through the coldest of Chicago winters–heavy duty gloves, face mask, ear warmers, long johns–are sitting lonely in a box this winter.

This is the first winter at my new job where, most days, I work on Chicago’s near north side. My commute has me going conveniently straight east from my home in Oak Park. Though this winter this commute will be exclusively done by automobile.

Computers are getting smarter, better, and more personable, there’s no doubt about it. Will there ever come a time, however, when computers get so good at human interaction that even the highest-skilled in the work force — primary care physicians (PCPs) — go the way of the travel agent?

I began wondering this a few months ago after listening to Dr. Martin Kohn, a physician who works at IBM Research and works on integrating the Watson supercomputer (of Jeopardy! fame) in healthcare. He spoke about computer technology changes, their history, and their integration with healthcare.

Could computers be the biggest disruptors of healthcare delivery (and my career as primary care physician)? Here are five reason why, one day, primary care physicians could possibly be replaced by computer…

Farmageddon 2013 is pretty much over. A few carrots, kale, and bok choy are still in the ground, but most of the other crops are fully harvested and the plants removed. Compost has been tilled into some of the the spots in preparation for Farmageddon 2014.

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Dr. Ravi Grivois-Shah, MD

Dr. Grivois-Shah is a family physician who practices in Tucson, Arizona. He is interested in health policy, health care leadership, population management, and how our primary care work force improves health access and outcomes for our patients and communities. Click on the "about" tab to learn more about Dr. Grivois-Shah. All opinions expressed on this page are solely his own, and does not reflect any employer or organization with which he is affiliated.